Claim Operations Specialist

• Serve as a customer service representative for the claim department
• Triage and route callers to the appropriate department
• Answer claim status and payment questions
• Partner with claim professionals to assist with timely claim resolution
• Document claim files, including notes and diaries
• Request reports and records and review medical bills, mail, and wage statements
• Prepare claim documents for legal and medical reviews
• Report and assign claims and transition closed files to and from off-site storage
• Receive, sort, scan, upload, and process incoming and outgoing mail
• Order, receive, and distribute supplies and/or equipment
• Process and issue claim payments, vendor invoices, attorney expenses, and medical processing fees
• Process and document returned checks, voided checks, and credits
• Prepare, generate, and review operational, line-of-business, and financial reports
• Update data discrepancies in reports and systems
• Document pending and completed work activities
• Perform underlying financial controls and communicate findings
• Assess data reasonableness, identify discrepancies, perform reconciliations, and assess financial controls
• Prepare data entries according to established standards
• Perform other duties as assigned

• High School Diploma or GED
• 1 year of service-related work experience OR Bachelor's Degree
• Experience utilizing Microsoft Office, e-mail, Web-enabled applications, and database software
• Ability to analyze and compare information to understand issues and explore alternative solutions
• Verbal and written communication skills
• Ability to exercise sound judgment and make decisions
• Ability to build and maintain productive working relationships
• May require lifting items up to 20 pounds occasionally

Demonstrates strong customer service skills while effectively managing claims processing and documentation. Proficient in data analysis, financial reporting, and maintaining accurate records to support timely claim resolution.

• Customer Service Representation
• Claims Processing
• Data Analysis
• Microsoft Office Proficiency
• Verbal And Written Communication

• Claims Documentation
• Financial Reporting
• Data Entry
• Reconciliation
• Medical Bill Review

• Sound Judgment
• Decision Making
• Relationship Building

• High School Diploma
• GED

• Claim Status
• Claim Payments
• Operational Reports
• Vendor Invoices
• Financial Controls

• Database Software
• Web-Enabled Applications
• Email